Provider Demographics
NPI:1205014123
Name:SEREJCH, NANCY ANN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ANN
Last Name:SEREJCH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:SMALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:7520 30TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3327
Mailing Address - Country:US
Mailing Address - Phone:206-910-3356
Mailing Address - Fax:484-993-3603
Practice Address - Street 1:9001 35TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3327
Practice Address - Country:US
Practice Address - Phone:206-910-3356
Practice Address - Fax:484-993-3603
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023810225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist